Krohn CD, Reikerås O, Bjørnsen S, Brosstad F. Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery.
THE EUROPEAN JOURNAL OF SURGERY = ACTA CHIRURGICA 2001;
167:168-72. [PMID:
11316399 DOI:
10.1080/110241501750099276]
[Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE
To evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion.
DESIGN
Prospective study.
SETTING
National hospital, Norway.
PATIENTS
9 patients operated on for thoracic scoliosis.
MAIN OUTCOME MEASURE
Concentrations of plasmin/antiplasmin (PAP), alpha2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood.
RESULTS
In drained blood the concentration of alpha2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 microg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 microg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood.
CONCLUSION
The systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available alpha2-antiplasmin in the wound and result in postoperative rebleeding.
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